Save Public Medicare! Information
ONTARIO HEALTH COALITION
The Pulse February 2008
Public Hearings on a National Public Drug Coverage, called “Pharmacare”
Health Coalitions across Ontario are conducting hearings with local MPs to collect personal stories about access to drugs, briefs, and policy positions and proposals for a public drug insurance plan and better pharmaceutical management. Come and tell your stories — all welcome!
Sarnia – held their hearing with representatives of all federal political parties on Monday. Participants described their difficulties getting rare and costly drugs covered, or told of their problems getting responses from Ontario’s Trillium Drug Program. One woman described how her family has gone into debt to cover their drug costs, risking the loss of their house. A representative from the Communications Energy and Paperworkers Union described the increased pressures at the bargaining table negotiating benefit plans for their 2,000 local members. Thanks to the Sarnia Health Coalition for organizing such a moving and important meeting.
Kitchener – Wednesday, February 6, 1 – 3 pm Kitchener Public Library Auditorium, 85 Queen Street North
London – Thursday, February 7, 1- 3 pm Kiwanis Seniors’ Centre, 78 Riverside Drive
Sudbury – Friday, February 8, 1 – 3 pm Finlandia Nursing Home, PK Salie Site 233 Fourth Avenue
Ottawa – Tuesday, February 12, 1:30 – 4:30 pm Public Library Main Branch, Auditorium, Corner of Laurier/Metcalfe
Hamilton – Friday, February 29, 1 – 3 pm Sackville Seniors’ Centre, 780 Upper Wentworth St
Town Hall Meetings Regarding Hospitals
Brampton – Community Briefing and Discussion on what is happening with the P3 deal and the redevelopment of the Peel Memorial Hospital
Thursday, February 7, 7 – 9 pm Bramalea Civic Centre, 150 Central Park Drive
Woodstock – Community Briefing and Discussion on what is happening with the new P3 Woodstock Hospital
Wednesday, Feburary 13, 7 – 9 pm , 576 Brant Street
Welland – Town Hall Meeting on Our Hospital. Local MPP Kim Craitor has called for a provincial review of the Niagara Health System – including our local hospitals. Concerns have been raised about care, budget cuts, staffing shortages and the P3 redevelopment at the St. Catharines site. All welcome for a community briefing and discussion.
Wednesday, February 13, 7 – 9 pm, Public Library on King St., Welland
—————————Updates on Key Issues
Nursing Home Minimum Care Standards
The Ontario Health Coalition brought residents, advocates, careworkers and health professionals together to determine a list of key issues for Long Term Care facility reform prior to the new Act. At the top of everyone’s list was inadequate care levels. Since the spring of 2006, we have been advocating for the adoption of a minimum care standard that would guarantee 3.5 hours of care, on average, for nursing home residents.
The Minister of Health has appointed Shirlee Sharkey to review minimum care standards for nursing homes. Ms. Sharkey is the President of St. Elizabeth Health Care, a homecare agency. While St. Elizabeth is in the non-profit sector, it has been controversial for pioneering the adoption of the cost cutting in working conditions – a tactic of the for-profits in homecare.
Both the Minister and Monique Smith committed to bring in a regulated care standard during the new Long Term Care Homes Act hearings last spring. A regulation is a piece of law, passed by Cabinet, that makes specific directions under a piece of legislation. After the Act passed, we were told that the promised care standard regulation would be brought in during the summer, subject to the normal consultation process for regulations. Then we were told that the province intended to appoint a “facilitator” to determine specific elements of the standard, after which a regulation would be introduced. During the election, Premier Dalton McGuinty promised a care standard regulation within three months.
After the election, the Minister appointed Shirley Sharkee as a facilitator, but her Terms of Reference were unclear. In December, she made public her “Terms of Reference and Workplan”. These are extremely broad, and cover the whole gamut of care and human resources issues. It remains far from clear that she sees her work as recommending a minimum care standard as promised by the Premier and the Minister. We are worried that this review is much like the Elinor Caplan review of homecare the Minister claims that she is mandated to do the job promised, while she claims she is mandated to do something else.
Shirley Sharkee is slated to write an interim report for sometime in February. It is not clear if that report will be made public. Then she will write a final report in April.
The Ontario Health Coalition has organized “high level briefings” for all our constituent organizations on the issue of “Why is a minimum care standard our priority recommendation?”. These started in Toronto on Friday with the central seniors’ organizations, health professionals and unions and continued in cross-province briefings. If your organization would like a briefing, or if you would like a paper copy of our submission to Shirley Sharkee containing the research on this issue, please contact our office.Please fill in your nursing home petition and get it back to us asap!Upcoming release of reports on conditions in Ontario’s nursing homes across the province.
Available on our website at www.ontariohealthcoalition.ca (Click on Long Term Care in the left hand column) New! Submission to Shirley Sharkee outlining in detail the current situation in Ontario’s LTC facilities and the research regarding minimum care standards
Short Flyer on Minimum Care Standards
Fact Sheet on Minimum Care Standards
Fact Sheet on Non-Profit versus For-Profit LTC
Ownership Matters: a 2002 Report on Long Term Care Facilities in Ontario
Paul McKay’s excellent investigative journalism series on nursing homes in The Ottawa Citizen
Brampton P3 Hospital
At the beginning of January, the Ontario Health Coalition released a new report on the Brampton P3 hospital. Based on secret documents revealed after our four year court battle, and quotes from two Health Ministers, the Premier, three hospital CEOs and Brampton’s Mayor, the report traced the history of cost overruns and cuts in Brampton’s hospital plans. Like the evidence reported in the British Medical Association Journal, we found that hospital bed plans had been cut by more than 30% as costs for the P3 hospital doubled from $350 – $650 million. The new hospital currently has 479 of a promised total of 608 beds. Plans for a second hospital housing 112 complex continuing care beds on the old hospital site have been cut. The Local Health Integration Network is consulting on what should be done with the old hospital site, despite promises and announcements that there would be a second hospital redeveloped on that site. The coalition demanded an audit, a moratorium on P3s, and measures to increase the hospital capacity in Brampton.
Following a major protest organized by members of Brampton’s large Punjabi community in early December, the province appointed a supervisor who answers directly to the Minister of Health to take over the functions of the hospital CEO, board and membership.
In late January it was announced that the hospital CEO resigned, along with several hospital executives. In a debate on TVO’s “The Agenda” between coalition director Natalie Mehra and Minister of Public Infrastructure Renewal David Caplan, and others, the Minister claimed that he asked the Provincial Auditor General to take a look at the P3s. Asked if that was an official public audit, the Minister did not respond. We are following up with the auditor’s office.
New Brampton P3 report and summary: “When Public Relations Trumps Public Accountability”Report on the Royal Ottawa Hospital P3 by OPSEUAdditionally, there are many reports, analyses and releases over the last few years on the Brampton and Royal Ottawa P3 hospitals, as well as the newer projects across the province on our website under “Public Private Partnerships”.
February 7, 7 pm Town Hall meeting in Brampton at the Lester B. Pearson Theatre, 150 Central Park Drive, across from the Bramalea City Centre Mall and in the Bramalea Civic Centre Building.February 13, 7 pm Royal Canadian Legion, 576 Brant St. Public meeting and briefing session in Woodstock regarding the P3 planned here.
Finally and So Far:
George Smitherman Does the Right Thing Stopping Homecare Competitive Bidding…
At Least Temporarily
In 2001, just a few months after I came to the Ontario Health Coalition, we decided to research and write a report on the impact of competitive bidding in homecare. Called “Secrets in the House: Homecare Reform in Ontario 1997 – 2000”, it identified some disturbing trends that had become apparent as a result of this Harris government policy.
At the time, we were hearing horror stories such as that of a friend of mine. She had profound disabilities and relied on home nursing and support to live. She was repeatedly left at home, alone, unable to move and silently panicking as her care staff didn’t show up. The homecare company was unable to find replacement careworkers for absent staff. Staffing shortages became epidemic, as untenable homecare contract prices resulting from bidding competitions prompted careworkers to vote with their feet and leave the homecare sector.
Other issues we identified included extraordinary administrative costs and unnecessary duplication created in order to prop up the administrative structure required by bidding. Huge dislocations in personnel and serious concerns about quality and continuity of care also emerged as key themes.
We protested and lobbied over the years as the VON and Red Cross lost contracts in Kingston, Cornwall, Sudbury, and other communities. The Harris government structured the bidding system to enable for-profit companies to bid in and gain “market share”. So experience in providing the service was not counted towards the so-called “quality measures” in the bidding process. How else would companies that had no employees or no previous existence in a community be able to win a contract? This bizarre notion of a “level playing field” between the non-profits that had provided services for a century and profit-seeking companies looking to gain revenues from government contracts continued under the McGuinty government.
Late in 2001, we released an update to the “Secrets in the House” report. Called “Dip and Skip”, its title underlined how competitive bidding necessitated that that care work be reduced to “widgit”- like measurable chunks, each with an identifiable price, sacrificing care and flexibility so that pricing and bidding can occur. “Dip and Skip” was the term careworkers coined for the scant amount of time in which they were required by their companies to bathe frail, ill and elderly clients .
Revelations by the CCACs were becoming embarrassing to the Harris government. The Ottawa CCAC made public the significantly higher costs resulting from the government’s directive forcing the CCACs to stop providing service directly and contract out. CCACs across Ontario were complaining about budget short-falls and problems with access. In a highly publicized case, the Kingston CCAC refused to take more patients causing a backlog throughout the hospital. Harris’ response was a new piece of legislation that effectively wiped out all democracy in homecare, axing all community memberships in CCACs and allowing Cabinet to replace at will key Board members and CEOs. As was intended, the sector became totally secretive.
By the last year of the Harris government, the scope of homecare was being systematically cut. Home care was re-focussed entirely on post-hospital care. Home support services to allow the elderly to age in place were removed from public coverage. The dream of a system of long term care in the home was destroyed. This reduction in the scope of homecare coverage was completed in the first year of the McGuinty government. Literally tens of thousands of seniors lost their home support services. (Notably, the McGuinty government started to reverse itself on this last summer.)
In 2005, we updated our findings from the earlier reports, releasing “Market Competition in Ontario’s Homecare System: Lessons and Consequences” in time for Elinor Caplan’s review during the first moratorium on competitive bidding announced by George Smitherman. By this time, more than half of the homecare sector (which had expanded with steady budget increases every year) was taken over by for-profits.Competitive bidding succeeded in winning “market share” for its biggest boosters.
Our 2005 report found startling turnover levels among staff (ranging from 24 -70%), and loss of continuity of care that affected more than 20,000 clients in just a few months of that year. “Quality” in bidding was just a paper exercise. And “competition” had become, in fact, oligopoly, in which a few large companies controlled almost all of the contracts. Most disturbingly, the culture of the sector had begun to shift. Providers were competitors, not colleagues, and secrecy blanketed the sector.”Gag clauses” in the contracts that surely violate basic free speech rights, stop agencies and staff from speaking publicly. Non-profits took on the worst aspects of the for-profits, or lost bids. Large companies hired consultants to write bids and smaller community providers were cut out.
Today, Ontario’s homecare is more expensive than other provinces’. The theory of competitive bidding is that it stifles inflationary wage and working condition pressures by creating job instability. This is true, and the destruction of quality of worklife has led to extraordinary turnover, loss of continuity of care, and an exodus of staff to the institutional sectors.
But the impacts on wages and working conditions do not result in overall lower costs – just cost shifting. The proponents of competitive bidding ignore the extraordinary costs of administration required to set up and maintain a competitive market. In order to maintain “competition”, there need to be 8 – 10 companies operating in each area. That is 8 – 10 administrative structures, computer systems that need to talk with one another, bidding processes, pricing processes, oversight etc. In Ontario, there are duplications, redundant technology, and inefficiencies all through the system. In addition, profit taking eats further into wages and working conditions, as Professor Jane Aronson found in her Hamilton study. All of these costs take money away from care. In fact, Ontario’s homecare dollars flow through no less than four sets of administration before one penny goes to care. Like in the U.S hospital system where studies have found 16 – 30% higher costs than Canadian hospitals largely due to administrative costs for billing and pricing, homecare in Ontario has become “bar code” medicine.
The Health Minister announced on January 28, that there is another moratorium on competitive bidding across Ontario. He noted that the Ministry has some policy work to do. This time we must make them listen. Competitive bidding is profoundly damaging to integration, democratic transparency, decent working conditions, continuity of care and cost. It needs to be stopped permanently. It is time to heal homecare.
Natalie Mehra, Director
The homecare reports outlined in this article can be found on the OHC website at
www.ontariohealthcoalition.ca (Click on “homecare” in the left-hand column or use the search function)